Provider Demographics
NPI:1255888053
Name:TRUJILLO, HEIDI JOY (NP-C)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:JOY
Last Name:TRUJILLO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:JOY
Other - Last Name:DAVENPORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 THREE RIVERS DR NE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-4999
Mailing Address - Country:US
Mailing Address - Phone:706-232-1300
Mailing Address - Fax:706-232-1039
Practice Address - Street 1:140 THREE RIVERS DR NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-4999
Practice Address - Country:US
Practice Address - Phone:706-232-1300
Practice Address - Fax:706-232-1039
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN251007363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily